The CARES initiative will expand the Community Independence Placement Project, add a new psychiatric respite center at San Francisco General Hospital that includes peer counselors; provide new support for family members and Transitional Aged Youth; and additional case managers to care for residents with severe mental health and substance use issues. This initiative will also support a longer-term effort to advance Citywide data-sharing and coordination practices.

“We have the strongest social safety net in the nation, spending $2.7 billion every year, yet we still have far too many people unable to make the choices they need to save their own lives because of severe mental health and substance abuse issues,” said Mayor Lee. “These hard-to-reach individuals oftentimes do not access the vital treatment they need and the new CARES initiative will help by strengthening our current behavioral health system of care for those that need it most.”

“The collaborative and engaging meetings of the CARES task force helped to refocus the City’s much needed attention on those suffering from mental health issues in our community who are currently falling through the cracks in the City’s mental health services system,” stated Supervisor Mark Farrell. “I fully support the policy and programmatic recommendations that came out of the CARES task force and look forward to working with the Mayor, my colleagues, and the community to better provide care for those who are most vulnerable.”

In an effort to ensure recovery and success for this population of residents, Mayor Lee directed Health Director Barbara Garcia to form the CARES Task Force, a 21-member advisory body charged with developing a range of policy and programmatic recommendations designed to serve those residents with the most challenging symptoms—those with a severe mental health diagnosis and/or a history of substance use, a chronic medical condition, unstable housing, underemployment, and limited family connections. Oftentimes the same person is simultaneously engaged with police, service providers, probation officers and clinicians, without getting the real consistency in services that they need. The prevailing conclusion from the CARES Task Force is that San Francisco has a robust service mix that can prevent increased engagement with the criminal justice system, but current coordination efforts do not embrace the full reach of the system. The CARES Task Force recommendations developed the CARES initiative.

In the past year alone, San Francisco jails have served almost 800 inmates diagnosed with a psychotic, bipolar or major depressive order. This number excludes individuals on probation or Post Release Community Supervision (PRCS), or the roughly 2,300 individuals served at any given time through our Behavioral Health Court, Drug Court, or the Community Justice Center combined. San Francisco also has regularly 750 people conserved because their disease has progressed to that of a grave disability—which means that a person is unable to utilize the means available to provide for basic necessities, such as food, clothing or shelter.

To address this, Mayor Lee is making permanent and expanding the Community Independence Placement Project, which relies on the court system to compel treatment but takes the additional step of requiring medication compliance. Expansion may include incorporating patients from other hospitals (program is currently limited to San Francisco General Hospital) and those participating in probation-related and re-entry programs. Health experts estimate that there are hundreds of people who could immediately benefit from a stronger public conservatorship program encompassing mental health and substance abuse like this one.

To engage individuals before they reach an acute crisis point, Mayor Lee is creating a new psychiatric respite center at San Francisco General Hospital and Trauma Center, which will provide a secure and safe environment within the community for those that need support in staving off a crisis. DPH will employ a scaled launch starting in Fall 2014, and will staff the facility primarily with peer counselors 24 hours a day, 7 days a week. At its eventual maximum capacity the program will accommodate up to 12 individuals for over-night stays and up to 25 individuals during the day.

“We are world renowned for our trauma and crisis care response and the CARES advisory council has provided recommendations to improve the use of these services by recommending new program ideas that can improve our care to those impacted by addiction and mental illness earlier and more effectively,” said Barbara Garcia, Public Health Director.”

Not all of these individuals show-up in the City’s data systems, and therefore pose a unique challenge to outreach workers trying to make meaningful initial and ongoing contact. To address this, Mayor Lee has asked the health department to explore advanced data-sharing and coordination practices. The Mayor will also adopt a peer-based approach at the psychiatric respite center, as well as fund a family specialist to support families impacted by a loved one’s disease and a new caseworker to engage Transitional Aged Youth specifically. DPH will also add two Intensive Case Managers to absorb this increased and coordinated service reach.

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